the administration program which i will take this opportunity to say not a lot of plans are uniformly wonderful. it's a good idea to have a program to rate them. the demonstration was not a good program. it does not reward good performance and it needs reform so it actually does. ..

david then conversely say how terrible it is. what you -- you can have it both ways. in 2009 prior to the passage of the aca the rates paid to medicare advantage plans exceeding that traditional medicare but about 18%. the aca required changes to medicare advantage payment rate to better align with the costs associated with traditional medicare. these changes were estimated by the congressional budget office disabled a $135 billion over 10 years. so you can't have it both ways. every time we identified a way to save money, my colleagues on the other side of the aisle say, this is so terrible, this is being cut, that's been cut, and then they claim that the aca is causing costs to rise. can't have it both ways. according to the 2010 medicare payment advisory commission report to the congress, the 2009 medicare spent about $14 billion

more than the fisheries -- beneficiaries enrolled in medicarmedicare advantage plansn would've spent if they stayed in traditional medicare. i want to go along the lines of the question that mr. sarbanes did and asked ms. gold, how did we get to the point where we are paying so much more for private insurers through medicare advantage to provide medicaid benefits? isn't it accurate that reforms in the aca will help correct the overpayment problem in medicare advantage plan and payroll and extending medicare solvency for all beneficiaries of? >> yes, i think it will have that effect. >> okay. let me -- i think it's also worth noting that all of the cuts to medicare that were included in the aca were also included in each of the republican budget proposals for the last three years. so under a republican proposal these cuts to medicare advantage were continued also.

i want to mention the way we measure this solvency is by the medicare trustees report, and the trustees report shows post-aca solvency in medicare is extended, and i think that's important to state as well. mr. baker, i know that the past there've been concerns about medicare advantage plans cherry picking and seeking to enroll the healthiest seniors, leaving sicker beneficiaries enrolled in traditional medicare. have you seen evidence of this practice continuing our what steps the aca take to try to stop this practice? >> once again i think a provisions in the aca that require medicare advantage plans to have similar cost-sharing or benefits that are typically used by sicker beneficiaries, by that i mean renal dialysis, nursing facility care and chemotherapy is one of the ways that those plans t have become more attractive to those sacred beneficiaries and our a way

that, something the plants get used to kind of cherry-pick healthier beneficiaries over sicker beneficiaries. i think what we see anecdotally and it's born of by some of the research is that folks typically to join a medicare advantage at a relatively, the younger and healthier age. as they age and become more chronically or severely ill, they do this enroll. some dude this enroll and enroll in medicare traditional medicare with the thinking that certain treatments, certain providers are more unavailable in the original medicare program. so we do see that pattern emerge anecdotally in our work. >> thank you, mr. baker. let me ask you this question on a different question. in new york, we have about 2100 physicians eliminate from united health medicare advantage providing network and its expected impact about 8000 of new york seniors.

this was a business decision made by a private company and dcms everybody by law to say that from anything in the payment arrangements between private health insurance plans and health care provided. but i do see them as we use the authority it has to which are adequate provided networks are this all medicare advantage plans 12 ensure beneficiaries havofaccess to health care serv. so let me ask you, since they are no longer part of the specific medicare advantage network, what suggestions would you offer them. my understanding is more than 90% of physicians in america are willing to accept new patients under the traditional medicare program. so it's moving to traditional medicare an option for them right now? >> moving back to the original medicare is an option right now are moving to another medicare advantage plan. it's orange than most of those positions and most of the hospitals or other providers that have been dropped from united or other managed care networks are in of the medicare

advantage networks or are in as you said in the original medicare program. so this happens every year to some extent, and so our advice is consistent with industry to look for another plan that has your provide in it, or return to the original medicare program if that's a better program for you over all and your provider is also involved in that program. >> thank you, mr. chairman. spent now recognizes the gentleman from florida, mr. bilirakis, for five minutes. >> thank you for this very important and. i think the panel for the testimony as well. dr. caplin -- excuse me, mr. kubba, i was reviewing a report about a medicare advantage provides better outcomes and greater savings than traditional medicare. why does the cabinet and may produce such dramatically better results of? >> i think there are probably two or maybe three things to take away the drive that. one is the alignment of of incentives. when eddy county were i think

will understand that the incentives are line between those who pay for health care and those who provide the health care. without alignment things tend to be more productive in how they perform. second point is that because of that alignment what happens is there's a huge investment in preventive care. so when have the same goals and working towards the same, they will try to avoid these acute interventions to fix something that's gone dramatically wrong so they work with the member or the patient to try to manage them through. and the third point i would want to emphasize which is what dr. margolis said which is at issue around any of these members become very sick with time, age, as well as where they are socioeconomically. when they are of the sickest portion o of the 5% the drive to 52% of the cost, that requires even greater intervention and greater coordination. and so when these ideas of coordinated care and aligning

centers are very important, all assets of health care is extremely important towards the more chronically sick individuals. >> thank you very much. mr. holtz-eakin, 40% of seniors in my district had medicare advantage plans. so they love their plans, and it's very popular in my area. of course, again they like the plants. back in 2010, cbs chief actuary did a report on the impact of obamacare to medicare advantage. he wrote and i quote we estimate that in 2017 -- i know you touched on this, but elaborate, please. we estimate that in 2017 when the m.a. provisions will be fully phased in enrollment in medicare advantage plans will be lower i about 50%, does this track with your own analysis of these cuts of? >> apps alluded. as you for today medicare advantage is a high quality program, very popular.

even more popular nationwide. the senior population is rising 10,000 beneficiaries every day. one would expect that if nothing else changed you would see more enrollment, a lot more. we are going to see less. what's changed is a financial foundation, the cuts under a maple make it impossible for plans to survive and those that survive will have to change the networks and their benefits and the cost-sharing in ways that seniors will find under struggle. the net result will be less availability of medicare advantage. >> next question for you. some democrats have been pushing the accountable care organization, acos, as a model for better care coordination and better cost savings. doesn't medicare advantage for most the same concept with a proven track record of better outcomes and costs and payment? >> m.a. has a track record and it's by and large a high quality track record as i said earlier, not every m.a. plan is created equal but it has a track record. acos our concept at this

point, and unproven. there's one big difference. seniors choose their m.a. plan. seniors are assigned to the aco and they have no choice. that's a significant difference in the two concepts. >> thank you very much. i yield back. >> now recognizes the gentleman from north carolina, ms. ellmers, for five minutes. >> thank you, mr. chairman. and thank you to our panel for being here on this issue. serving the second district of north carolina, and i've been hearing since the rollout of obamacare that my constituents who are losing their medicare advantage are very, very concerned about this issue, as you can imagine. and it's showing in north carolina that the cuts to benefits for seniors for medicare advantage are over $2000 per beneficiary. now that we are seeing this play out, the things i'm hearing from my constituents are that they

are losing their access to care to their physicians, the cost is going up, and again, as you can imagine, they are very, very concerned about this issue. the mr. holtz-eakin, who again is going to be most affected by these medicare advantage cuts? which sector a population of our seniors? because i keep hearing over and over again that it's helping our chronically ill patients who have this coverage, and this is a better plan for them. is that not who we are harming? >> again, this is a better plan for those with more chronic disease in particular that have carefully courtney lee care. typically lower income, typically more minority dissidents in m.a. that's the population that would be affected, no question about it. >> can you identify some of the actual tangible benefits?

i know you talked about coordination of care and items like that the other any more specifics so that we all have a better understanding of what we are actually losing? >> i will let speed at dr. margolis -- i have another question for you, dr. margolis on the issue. you had identified quite correctly that we really need to be talking about taking care of those patients who are at the end of life, the ones who, unicode we know those are the ones that don't are we being spent. how do you feel about the independent payment advisory board? that's going to come into play, don't you believe? >> yes, ma'am. i survey do not believe that organizations like that should make decisions about individual patient care. on the one hand. and let me just say relative to that very sensitive topic. almost nobody wants to die in a

hospital -- >> thank you. >> they have support at home. and with coordinated care, integrated programs, spiritual counseling, palliative care, pain management and 24 access to caregivers, you can avoid almost everybody having that unfortunate event in the family. that's a big opportunity, and let's support special needs programs, the dually eligible, and move towards medicare advantage much more aggressively. >> i appreciate those comments. and that is exactly why i'm concerned about this issue as you are. and ms. gold, i just had to ask a yes or no, isn't that what you identified a few months ago when you said that you thought coordination of care could be better served under another plan and under a formal care act that actually happens? >> i think there's a lot of problems with getting coordinated care spending a

doesn't that do that? >> no. only some plants do. it has the potential -- >> okay [talking over each other] spin clarification. i did not say that every medicare advantage plans by dissident medicare advantage plans offer these benefits. is that yes or -- >> yes. >> thank you. just to finish out we've got about a minute and this question is actually the mr. holtz-eakin and to mr. kaplan. we've heard the bipartisan concern to, and we want to make sure we take care of our seniors. but we can say over and over again the affordable care act is so negatively affecting our seniors with their medicare advantage plan. just coming from a completely bipartisan perspective, what can we do now moving forward? what would you like to see in medicare advantage that we can move to that we can actually make a difference? because we are going to have to make changes in medicare, yes,

and i would like to know from both of you what your thoughts are on what we need to do in medicare so that we can make it better for our seniors. >> well, i think it's very important that we have a sustainable social safety net for seniors. medicare needs to be a different program in the future both financially and because of the care that seniors need that's different than when medicare was founded. medicare advantage is a great steppingstone to the future. it's not the end but it's a great steppingstone but it needs to be preserved, not wither on the vine in the next five years spent but we need financial backing. >> the near term would be risk adjustment issue that dr. margolis mention. buries his concerns in terms of funding. >> mr. kaplan, very quickly if you can add to that. >> my simple answer is that partnership, public-private partnership has been very successful and, therefore, in my mind we should invest in debt and make it better as opposed to cutting it back. >> thank you so much. thank you to all of you, and thank you to the chairman. i went over my time, so thank

you for allowing me to do so. >> the chair thanks the gentleman appeared that concludes our first round of question. we will go to one follow-up per site. and dr. burgess, we'l we will bn with five minutes of follow-up. >> dr. holtz-eakin, i want to follow up on the stuff we were talking about earlier in that first round. it appears in washington today there is a crisis in common. the president has sold the affordable care act on just a raft of false premises. you can keep your plan. false. you can keep your doctor. faults. these are broken promises and these in fact are the opportunity cost that americans are paying for the affordable care act. there was a promise made to seniors as well, the promise was that we're going to use your medicare dollars as a piggy bank to fund the affordable care act, and in doing that we will improve medicare and seniors to keep their doctors if they liked. so do you have an opinion as to

whether not this is yet another broken promise? >> it is spent and is it fixable? >> it is fixable in medicare advantage. i don't believe -- it is fixable. it is the problem but we should be on fixing medicare advantage in the ways we described earlier, and -- >> but the promises are -- just that, promises but if you like your individual policy can you can keep it. but the regulations and the funding are at odds of the promise. the promise can't be held to. >> so fixing it would be involving alteration of the founding? >> also true. >> at the present d.c. anyway or any mechanism by which that could happen? is anything that would give you optimism that attorney-in-fact could be restored the? >> under current law it won't happen. we need to change. >> let me ask you this. i wasn't here in 1988, 1989. i don't know if you were involved space on the old, yes.

[laughter] >> but there was -- dan rostenkowski, the democratic chair of the ways and means committee put together a catastrophic care program. he was very proud of it, passed the congress, bipartisan vote as i recall. they all went home satisfied with what they had done. and then something odd happened. people rejected what the law that was passed. they rejected it largely because it in a similar what is sort of moot funding around anyway that seniors thought would be deleterious to their well being. so then do you know what happened this spring after that? >> after they got the bill and after a chase them with the umbrellas, they repealed the law. >> so there is a mechanism by which this problem could be fixed also if we follow the 1989 repeal as precedents. >> there's no question this is fixable. it requires the congress to act

and the president to sign. >> it may require people with umbrellas to chase the chairman down the street. >> no comment. >> i do have to just address the issue, or ask, we have all these experts in front of us. we get reports that cost in medicare has come down. in fact, we are going to get him by the end of this week i think the congressional budget office is going to give us a projection of the proposed cut in the sustainable growth for which is likely to be less tha than what everyone when i went anticipating to commit improve the score for repeating it. a lot of opinions as to why this cost reduction is occurring. i don't know that it's had time. certainly is playing a role but i don't know if it's entirety of it. we are here just literally 10 years past the signing of the medicare modernization act with the provision of medicare

advantage and the medicare prescription drug benefit. and if we really to believe that it's better to stitch in time saves nine and is better to treat early before it is used its well-established, perhaps we are seeing some benefit from passing the medicare modernization act. to any of you have an opinion as to whether not that maybe playing a role in these lower costs? >> i don't know how much of the current slow down and health spending would contribute to prescription drug therapy but we know that others have found a party program has reduced cost elsewhere in medicare. and that's been an important part of the change in the cost structure of medicare. it's also been important part of structure of entitlement, the party program which allowed this 10th anniversary on sunday is probably most successful on entitlements. we should try to model every reform we can as closely as possible. >> that was constructed to be

more like insurance and less likely entitlement if i recall those discussions. i want to think they put on the panel. i know it's been a long morning. mr. chairman, i yield back. >> now recognize the ranking member, mr. pallone, for five minutes for a follow-up. >> thank you, mr. chairman. i just wanted to say, i'm going to ask my question to mr. dacre, but i just want to say with regard to mr. holtz-eakin's testimony with regard to acos, i just disagree. with acos and traditional medicare, seniors have the ultimate choice. vacancy any provided they want. they are not logged in for your life you are with an m.a. plan. that's just my opinion. when i heard you say, talk to acos i just want to express my view, which is that they are not blocking. they can choose whoever they want with acos in a traditional medicare plan. nester baker, i just want to ask you about how medicare advantage

can be improved. i think all of us here today agree that the medicare advantage program is a crucial alternative to traditional medicare, especially for individuals with complex health care needs. but in your opinion based on your organizations work over the years in assisting medicare beneficiaries, what recommendations do you have for how the medicare advantage program could be improved for beneficiaries? >> of course. i mean, i think the promise when it was initially put forward in the mid '90s, mid '80s in the mid '90s, the push was that it would actually say the federal government money and provide coordinated care in additional benefits to people with medicare. i think we've talked a lot about the advantages of medicare advantage, but some of the promise hasn't been met. as we've talked some of the plans are better than others, but overall the level of cornea care does vary widely amongst plans. and so we think better monitoring and oversight by the center for medicare, medicaid services to make sure that those promises are kept.

once again, better information about appeals within those programs. people call us when you have problems. consistently what we see in the medicare advantage plans are problems with access to care with utilization management or other barriers put to a variety of care. and we work with physicians and the plans to ease those barriers for people with medicare and medicare advantage. so having that information publicly available about which plan and how they are really kind of setting up maybe unnecessary barriers would be helpful. and enable people to not only compare benefits but also to compare have those benefits are administered by particular plans and making sure people are choosing those plans that actually orphaned the promise that a lot of us have talked about with regard to a coordinate care. and i think once again, with this idea of custom tailoring

stars, the stars program while it's good, needs to be better in that people really want to know when you're looking at your two cars and consumers reports from chris dudley starts overall but also on engine performance and a great performance and other kinds of performance measures. so we'll get to the place where i think we can customize those stars even more and that will also help folks choose between the program but i want to reiterate that i think the original medicare program or the traditional medicare program which we've had since 1965 is the bedrock. it is something that people continually kno know it's thered go back to. and it has, regardless of a lot of what he said, if you look at over the last 30 years, medicare, the traditional medicare program and private insurance have done about the same job. curtailing costs, good or bad. i think there's a lot of improvement that could be made in original medicare but there's

also a lot of improvement that could be made in medicare advantage as well. >> i only have a minute left, but some people including you have suggest we should consider establishing a so-called medicare part d which resulted in original medicare without beneficiaries having to pay for the overhead and office of private insurance plans. and it interesting. could you just elaborate a little on how you would envision that would be structured i would be an improvement to the current medicare structure? you have a minute. >> i think the commonwealth fund and others put together a more comprehensive proposal on what's called part e medicare and basically what it would do is combine part a, part b, part d, prescription drugs, and medigap. supplemental in a governmental run program. this would go toe to toe with medicare advantage and with the original medicare program as it exists now. once again it's an alternative. it's something that would sit alongside and it would allow more choice for consumers, and

could have a lot of the coordinated benefits and coordinated coverage that we've been talking about today. so i think it is something that would put together in one place, government run programs that has all of these components that people with medicare value and need, and could save money. >> thanks a much. thank you, mr. chairman. >> the chair thanks the gentleman. the chair thanks all the witnesses for your testimony. it's been an excellent hearing. very informational. the members may have follow-up questions. wheels but those to you invited to please respond probably. remind members that 10 business days to submit questions for the record. so they should submit their questions by the close of business on wednesday, decembe december 18. without objection the subcommittee is adjourned. [inaudible conversations]

[inaudible conversations] >> you can watch this anti-hearing again any time online at our website, c-span.org. coming up later today a house

veterans affairs subcommittee will hold a hearing on the government efforts to process complex disability claims. a hearing will focus on cases of traumatic brain injury, post direct stress disorder and sexual assault claims. the panel hearing includes retired veterans can legal advocates and officials from the veterans affairs department. jon runyan chairs the committee on disability assistance and live coverage will start at 3 p.m. eastern here on c-span2. >> friday on c-span, "washington journal" looks at the mission and role of the national institutes of health. starting liv line at 7:30 a.m. s with director francis collins on their medical research priorities. future projects and the impact of sequestration. at eight, allergy and infectious diseases director anthony fauci followed at 8:30 a.m. by eric green, director of the national human genome research institute. at nine, national cancer institute director harold

varmus. and at 9:30 a.m. and look at the national institute of mental health with director. all with your calls and comments live on c-span. >> as you walk in to our tables out in front with lots of pamphlets. not, prior to entering the country. the templates country. the templates are haul out the government is trying to take away rights trying to take what he writes him down and become as in this and vomiting that and obamacare star will. so those with the guys i wanted to talk to because they are the guys with the leaflets, the ideas. so i said to them, who are you? i said actually i'm academic. on research and i'm doing research on these organizations, these ideas and trying to understand the guys who care about it and then setting many believe this stuff. a bunch of them looked at me suspicion and said, start asking the question. and i just said, look, here's what i am. i don't get it. but here's my job.

i want to understand how you guys view the world. i want to understand that your worldview. look, you will not convince me and i will not convince you. that's off the table. what is on the tidbits i want to understand why you think the way you do. do. >> downward mobility, racial and gender equality. michael kimmel on the fears, anxieties and rage of "angry white men" sunday night at nine on "after words," part of booktv this weekend on c-span c-span2. >> next, white house chief of staff in this but dawn on the past problems and current status of the healthcare.gov website. effect health care was the most completely shoot he'd ever dealt with. he is all by former senate majority leader tom daschle his remarks focus on the unique challenges of making the american health care system more affordable and effective.

>> well, matt and ed, thank you do much but it's nice to see all of you this morning on a wonderful morning to talk about a very import subject for this country. a cherokee indian chief once said that success of a rain dance events a lot on timing. timing is everything, isn't it? pattani to talk about this subject is right now. the implementation of the affordable care act, opportunities and challenges. and we have i think an actual program today. we have two really terrific speakers, chief of staff of the white house denis mcdonough, from a jury of the u.s. senate tom daschle and then we have a panel that would be moderated by former senator bob bennett with the number of distinguished people on the panel. so that would be a day. we will have opportunity for some questions and answers along the road, let me now introduce the chief of staff of the white house, denis mcdonough. steel -- stillwater minnesota.

i assume the northern great plains spirit of denis mcdonough exists, and it is perfect for any chief of staff of the white house at any time. he said we were raised by people who taught us that life is an enormous struggle. and if that some and if that somogyi feel very happy, be patient. it's going to pass. [laughter] stillwater, minnesota, masters degree from georgetown university, was a chief foreign policy adviser for the majority leader of the senate, senator daschle, that's were i met den denis. then the deputy national street adviser in the white house and the chief of staff for the president of the united states. please welcome denis mcdonough. [applause] >> angood morning and let me sa,

let me say thanks to georgetown university and arent fox from this form on the affordable care act. let me say thanks to the great sin of the northern flank, senator dorgan answered daschle. senator daschle has been a very important mentor to me for the opportunity to be here. senator bennet, good to see you again as well. i appreciate the opportunity to talk about the affordable care act, what it's done and what it will do. and i want to update you this point on the progress we've made on fixing the website, affordable carhealthcare.gov. before talk about the law and its benefits, let me just take about to visit i made to the emergency room on a friday night recently. with one of my boys after he broke his left arm. they care was excellent, as so much of our emergency trauma and specialized carriers. that's a fact. but what was remarkable to me was not they care that my son

got, ma as grateful as i am for that care, but rather the crying of two babies are heard in the emergency room being treated for asthma, dramatic in fact asked attacks. i can't know for sure whether those babies were injured or not, but if they did have coverage, and acces the access t the primary care that comes with such coverage, chances are they would have been far less likely to be getting emergency care, or something like asthma him on friday night in the emergency room. and my heart broke for those parents who come its way possible, were left with no other option but to seek care for their suffering child in the emergency room. we are talking about asthma, something increasingly and sadly common, but also fundamentally treatable. dealt with in the emergency

room, which "the new york times" in great detail reminds us this morning is the single most expensive place to get treatment. now, there seems to be a strange outbreak of the stalls are here among some on the right in washington for the pre-affordable care act health care system. a system that covered too few people at a mattingly and efficient and often heartbreaking and ultimately very expensive way. the personal impacts are clear. think about that couple and their young baby in the emergency room on a friday nig night. but there's also huge cost and economic implications of that old system. runaway health costs inflation had been the norm until three years ago. and we spent far more as an economy in growth and per capita terms that all of the major economies for a system that

delivered less effective outcomes for a smaller percentage of our population. in short, quoting somebody i know well, we were spending more each year and getting less. our economy suffered, families suffered, and all of it was unnecessary. as president obama has said, fighting to deliver quality, affordable health insurance and the security that comes with it to every american is paramount. this is about making sure that everyone in the united states gets a fair shake, and it's about the economic imperative as we continue to rebuild our economy and build a better bargain for the middle class. that's what the affordable care act does, by using touchtone american values of transparency and competition to improve health care protection, and affordability to those americans who already have insurance, and to provide new affordable care

options for consumers who either don't have it or want to switch their insurance. we finally put in place real solutions that have been at work for generations, and we will continue for generations to come. now, reform and our health care system is not an easy task. i don't need to tell anybody in the room this or anyone who's read the newspapers the last few months. i will set worked on many competition issues to middle east peace, iran, budget deals. i can tell everybody in this room that reforming health care system is the single most complicated issue, and as the president often says there's a reason why folks tried for over 100 years and still hadn't until a couple years ago, done it. but is it worth helping americans get the care they need when they are sick? is it with protecting people from going back to bankruptcy because of an illness or injury? is it worth getting a grip on health care costs that are holding back our entire economy?

you bet it is. fixing a broken health care system has been a labor of love for the president. personal for him as it is for many of you in this room. the casinos that it is personal for each and every american. he knows that getting this right know matter how difficult, it's about making people's lives better. that's what the affordable care act comes down to these days. president obama is going to speak more about this and the affordable care act letter today. while i'm here with you led me spend some time describing how the law does these key things, providing security to american families, improving our health and also talk with how we're wee doing all we can to input the law the right way, fairly and flexibly. and that includes learning from our expenses with healthcare.gov. the bottom line is this. the affordable care act takes the most harmful a wasteful aspects of the system heretofore. millions of americans are

already feeling those benefits, including people who already have health care coverage before. let me give you a few statistics. thanks to the affordable care act, 105 million americans, including more than 47 million women, are paying less for preventive care. we are investing and keeping people healthy rather than treating them when they are sick. 105 and america's are no longer subject to lifetime limits on their coverage. up to 129 million americans, including 17 million kids, 17 million kids, who have a preexisting condition for which heretofore they could've been denied coverage or charged more are now protected because charging more or denying coverage will be prohibited as of january 1. and 7.39 seniors and people with disability reached the donut hole of medicare -- drug

coverage have saved $8.910 on their prescription drugs. this year alone the law itself a .5 million americans get money back in the pockets by making sure their premium dollars go to health care, not overhead of profits. in 2011 and 2012, 2.9 billion in premium savings were returned to americans as accountability and transparency policy taken. thanks to the affordable care act a new major marketplaces and the choice and competition encouraged will get the majority of uninsured americans the chance to buy health care coverage to less than $100 a month. think of that for one minute. heretofore uninsured people are now going to do their personal responsibly to get coverage, so that is their coverage that covers them, not the rest of us that cover them when they're forced to get treated in an emergency room. and thanks to the affordable

care act, states can expand their medicaid programs to cover even more lower income americans. many of whom are working for and don't have insurance, or don't have, pay enough to let them pay for it either. 25 states and d.c. have done the right thing and said yes to cover more people, clean states with conservative governors like ohio, michigan and arizona. if every governor follows suit and we could cover of another 5 million americans next year. another 5 million americans covered next year. we're going to keep urging those leaders to do the right thing and to expand coverage at no cost to themselves for the next year. a new report out today shows that in october alone, not counting states like texas or determinations through the federal marketplace, 1.4 million people gained eligibility and medicaid and the childers health insurance program. that's up 15% from previous months. and more is to come.

those are just a few highlights of the law. on top of these benefits to consumers the impact on our economy will also be profound. we are already a significant slow down in the rise of health care costs, and the lowest levels of health care price inflation in 50 years. in the short run lower health care costs increased numbers incentives to hire new workers. in the long run what we say about health care costs shows up in entire paychecks for workers and/or deficits the government. indeed, the cbo estimates that in the second decade the aca is in effect once it is in effect it will shave .5% of gdp off our deficit every year. which is about $80 billion each year in today's economy. "the new york times" reports this morning that the cost of the aca are heading in the other direction. so economic benefits are going

up, costs are going down. now, how do we implement all these benefits to make sure they translate to better care for everyone? because it will allow -- as i said, millions of americans have been benefiting from them since 2010. what we have to do is keep spreading the word so america's know that these options are available to them. for americans without insurance are working to help them get covered. this is where much of the attention has been since october 1. the new health insurance marketplace will help ensure millions of hard-working americans find affordable health care. in states where governors and legislators, candidates and state-based workstations will allow this to work for more other citizen. people are signing up in droves. 50,000 people have signed up for private health plans in new york. 80,000 in california. 9000 in kentucky. in other states utilizing the federal marketplace.

let me talk for a minute about that market place, healthcare.gov. as you know the website didn't work the way it should have on october 1. that's on us. that's on me. as soon as we realized there were problems we put a team of experts to work and as promised, the website is working better now and will work better tomorrow than it is today. and by the weekend better than that. we will continually improve. as of two days ago that he must double the websites capacity. theit can handle 50,000 users at once. over a 10,000 users a day. comfortably. the average response time has gone from eight seconds to under one second. response sending the measure of time you click from one page to another in the site. the number of people successfully enrolled in health plans is climbing while the error rate has gone from 6% to under 1%. inching closer to industry standards for websites.

so we are getting back on track and we'll keep improving the site as i just had to ensure that it's best for users. we are making the site more user-friendly. the new waiting and we instituted yesterday functioned pretty well. 13,000 customers requested that they be e-mailed, invited back to the site at an easier time for them to navigate. all of them were invited back in the same day. half of them chose -- accept the invitation to go back to the site the same day and they viewed on average 24 pages during the return to the site. while we are welcoming new users to the site and with over 1 million of them yesterday, although 1 million new visits yesterday, we'll also make a special courage to reach out to those users who have already submitted application but have yet to actually enroll in the

plan. and we will make should get those customers who have selected a plan do everything needed to to ensure the they're covered on january 1. we want to make sure that everybody is taking steps necessary, that they have that afford booker bridge come january 1. ultimately we believe to healthcare.gov will be the easiest way for americans to compare and buy quality, affordable health insurance. having brought transparency and competition to a market that heretofore has been closed and overtake. but as you for the presidency and i described it today, the affordable care act is much more than a website. let me close by saying this. we learn from our experience the past two months on healthcare.gov, and obama interest we've seen from consumers in the first two months of open in rome at reminds us just how strong the demand is for quality, affordable insurance options. and that strengthens our resolve to make sure that this law works for every american.

no matter what we're going to see this through. we're going to make this law work as the problems arise, we will fix them. just like we're fixing the website. and as president obama has been saying from the very beginning, he's working, he's willing to work with anybody, republican or democrat, to make this law work better. because the trendy, it's in the united states of america, affordable care act should never be -- afford booker should it be the privilege of a lucky few, but rather a right for every american. the affordable care act gives us an option to make that realistic. we intend to see this through. thank you very much for the opportunity to be with you. [applause]

>> this weekend he determined he wasn't able to be or for other reasons, and denis mcdonough, the chief of staff said, i'll, and i'll provide a speech and that was very generous of him as well. but you need to get back to the white house, so thanks to denis mcdonough. is a friend of some guy thinks served this country very, very well. next, the opportunity to introduce my friend tom daschle. tom daschle is from aberdeen, south dakota. there's a theme here. stillwater, minnesota, aberdeen, south dakota. i will tell any south dakota jokes today because tom has heard them all. but i will tell you that we have been personal friends for i guess almost four decades no. tom as i said grew up in south dakota. he is a military veteran. he got involved in politics and

became the majority leader of the united states senate. he i think is the only person who has ever served in leadership in the senate. he was majority leader twice and minority leader twice. over a long career, one of the longest in the history of this country. tom is a healt health care expe. he's written two books on this subject to elections across the subject of. is a very close personal friend. he's a senior advisor and he's agreed to join us today. and tom will give a presentation and take some questions and answers. tom, thank you very much. welcome tom daschle. [applause] >> byron, thank you very much for that generous introduction. thank you all for your warm reception this morning. i really appreciate the opportunity to be with you and to talk as denis edney, about

something that we all care deeply about. and i think it is appropriate that i'm the third in this line of midwestern speakers, minnesota, north dakota. the gateway to south dakota and it's only appropriate that i come third. denis and byron and i grew up in states where, in most of the kids you put in turning and leaving on the same post. those kids are about seven years old before they realize the name of the town isn't resume speed. so we have a lot in common. but obviously you can understand why i'm as proud of denis' work and his commitment to public service as i am this morning. i've known him for close to now 20 years. and i had the good fortune to work very closely with them even after i left the senate. he and i had the opportunity to work together, and so it's a real honor to have heard him this morning, to see him again

doing such good work. let me also thank arent fox and gw for hosting and sponsoring this important program. i'm sorry, george, did i say -- georgetown. of course, judy is here. but i really appreciate the opportunity to be with you and thank you for the leadership you have shown in making this possible. i was going to begin my comments by talking a little bit about what it is we should think about as we contemplate our current circumstances in health. but i think denis has done such a good job in laying out many of the things that i was going to address, but i think in the interest of time i will simply restate what is obvious to most people but and that is that we've made enormous progress over the course of the last three years. enormous progress in changing the paradigm of health, progress

in reducing costs, improving access and ultimate even committing to improve quality. and i think as we consider that progress, there aren't many things for which i think there's a lot more bipartisan agreement than we often read about in the news media or hear on television. i do want to talk all of it about what i think the areas of agreement really are and then get into some of the details about our future as we look to the enormous work that still remains with regard to health. obviously, this is a very transformational time. i would suggest, and assert, that it's the most transformational we've seen in health and all of our countries history. the magnitude of change that we have experienced and will experience over the course of the next decade is just the beginning of an appreciation of just what a transformational opportunity and challenge there

is. and therein lies both opportunity as well as -- those who would somehow resist this change and argued against making this new health paradigm a much more conducive environment i think ultimately stand to lose a great deal as we go forward. so as i consider the achievements and this transformational moment, the one thing i would say is that there are a couple of characteristics of the american health sector that are going to remain somewhat unique to america. the first i would argue is that unlike every other industrialized country, united states has never really had what i would call a system. we refer to it as a health care system, but if you define a system is having a central administrator and a central decision-making authority, we've never had that.

what we have is a collage of subsystems, both public and private here the medicare and medicaid systems, subsystems being some of the more significant public. our whole private health insurance, one of the more private systems but we also have entitlement care and the veterans administration. and uncompensated care that we all pay for in very inefficient ways, in the emergency room and in other ways as people are unable to pay for the own health care. so all of those subsystems that collage, represented one of our greatest strengths in that it has brought enormous innovation, but it's also extraordinarily inefficient, and the fragmented nature of those subsystems continued to plague and create problems that we are attending to address and that denis get a good job this morning in the alpine. the second characteristic of our health care sector is the nature

of our health care period. i've always advocated, asserted that all health in any society looks like a pyramid. where at the base of the damage of wellness and good primary care, and you become more and more sophisticated and more and more technologically inclined with the applications at the top of the pyramid being the most sophisticated we've got today. the heart transplants and mris. very technological application. well, that pyramid, it works about the same weight in almost every society where they start at the base and they work their way up until the money runs out. in the united states, we've always start at the top of the timid and worked our way down until the money runs out. the money runs out. so we don't really have the kind of emphasis on good primary care and good, a good wellness program that most other pyramid models offer in these industrial

is countries today. so those two characteristics are one that will continue to grapple with. were not going to have a system as we defined. we aren't going to have a bottom to top enemy but the real challenge will be, can become the anti-pyramid from top to bottom with better allocation of resources and greater efficiency? that's in essence what we're kind of you as we go forward. given those characteristics, let me just say i think there are a number of areas for which republicans and democrats, conservatives and liberals really find very little disagreement. i can't find a conservative or somebody on the left or the right who would argue that we don't have in the long scheme of things of real cost problem today. denis addressed it, and certainly we've made enormous progress in the last couple of years. we are now at the lowest cost growth we've seen all of history. but if you look at what's happened on costs in united

states, just think about the fact that we spend more on health and the next 10 countries in the world combined. we spend more on health and the entire gdp of india or russia or brazil. when i was born, health was 4% of the gdp. my children were born it was 8%. when my grandchildren were born it was 17%. and now we are told by the council of economic advisers that unlike enough to have great-grandchildren and historic trends continue would be 32% of gdp. there isn't a conservative or liberal in the world who will argue that that is not a problem going forward. as i say, we are making progress. but if we weren't making progress, the inevitability of that trend is something that we simply can't sustain. we also have no disagreement really with regard to the fact

there are a lot more people uninsured and not getting the access to care that they should any country as rich and as powerful and as good as ours. i'm lucky to serve on an advisory board at harvard, and the recently released a report that really struck me. my town, aberdeen, south dakota, a town of about 25,000 people, and the reason this report struck me was that this report noted that now on the average, every year about 25,000 people die simply because they have no health insurance. my town of aberdeen, south dakota, the equivalent, dies every year simply because they don't have access. i think that number is conservative. but i will tell you that is unacceptable in this day and age in this united states of

america. we also have a quality problem, and for that there is riddle difference of opinion. people on the left and right recognize that you don't even come into the top 20 of the criteria used for judging performance that outcome, something is wrong. but over and over again we fall fall -- far short even though we spend more than anybody else in the world. so we recognize that on cost, access and quality, it's not a political issue. it's not even an ideological issue. i would even assert, and i'll and -- i'll into my piece of bipartisan analysis on this, i would even assert that when we state what our goal is as we look at health going forward, that no one disagrees with the assertion that we should have a high-performance, high-value

health care marketplace with better access, better quality and lower cost. i don't know how you disagree with that, and i've never been in a venue with my republican colleagues who we spent a lot of time together talking about health, we all agree that that's what we're trying to do, build high-performance, high-value health care market place with better access, better quality and lower cost. what i find is that even though there's all this agreement on the problems, and i could even come if we had more time i could get into the causes for those problems, there's a significant degree of agreement on that. i'll just cite one, the lack of transparency. health care is the oe sector in our economy where at the time of purchase we don't know what it's going to cost or who is going to pay. we have more information, more staff on every sports figure that we do and every provider in this country. transparency is a real problem because you can't fix what you can't see.

we can't see what we have as problems on a regular systematic basis when it comes to health. there is no disagreement about that. the fundamental disagreement among republicans and democrats and liberals and conservatives today is really what is the proper role of government as we address those problems, as we address those causes and as we -- that's really where the divide is today. ..

the private or with regard to the insurance subsystems that i described a moment ago. for the first time in 2011. so we are at a 50/50 approach today in regard to health. as the affordable care was being contemplated, i would just take a minute to talk a little bit about history because i think it is important as thursday foot on the table. i don't think the president could nearly enough credit for it. i had many conversations with him and others over those early stages. i'll never forget as he was contemplating what model he would use, there was a lot of pressure in his party going back to government and say you know

what, what we have to have in this country is a single-payer system, medicare for all. that's what we need. medicare for all of, a single payer system like other industrialized countries like her. he notice the answer was? i don't think we'll ever get bipartisan support if we try single-payer system going forward. i'm going to take a heritage foundation proposal that they came up in 1993 and use that as the model and as the basis for the legislation because i want if we can find bipartisan. he said okay, well except that even though we think is a girl payer system would work better. at the very least, there ought to be a public auction. you ought to be about to go to every statement that medicare for all of that's your choice. he says no, i want to keep it by party scene. while never, ever get bipartisan

support if we have a public auction. so they said well, we strongly disagree, but at the very, very least, you have to let government negotiate drug prices do not importation, which is something byron really advocated for. having the ability to negotiate prices is what they do with the veterans administration. the president said i want to try to keep this a partisan. so he vetoed that as well. unfortunately we weren't able to get very far in creating the kind of bipartisan is that he really attempted to produce. but we are where we are. two pivotal moments occurred when a 12 to bring us to the current circumstances. those two pivotal moments of course it rained court decisions that the law is constitutional and backing the election where we chose one later who advocated one approach over a leader who

advocated another. as we look going forward to the next five years in particular, i would say that there are going to be a very specific levels within which all of this is going to unfold and for which we will see enormous transformational change. the first and most imminent factor perhaps will be congress itself. congress is unlikely to change the affordable care act, find the necessary those in houston tonight and get the the necessary presidential signature. i don't mix if any immediate changes if we start to the line cells. or we do have an enormous opportunity to change the public programs, medicare and medicaid, recognizing that is a significant budget and cost driver and realizing by simply changing these two major

programs, they can be engine for change in the entire health care marketplace. been there, congress has a choice between cutting programs and shifting those costs on to somebody else, which we've done all too often, are redesigning and improving those workers unaware that can bring meaningful change, greater the can fire more opportunity for improvement in access cost and quality today. i am very hopeful that over time congress will choose the latter and look at the ways with which many organizations already offered suggestions for redesigning and improving. one that her cancer released report that gave a significant analysis of programs and ways in which they could be redesigned and improved, bringing down costs and improving quality. so that's the first level in a

very important model essays that will be necessary at some point going forward. the second level is the chorus. there's a couple stories in the papers today about court challenges that mandate, court challenges on contraception from independent payment advisory board, a number of us are very critical issues that are yet to be resolved legally. those issues are still pending at various levels to the course upon the very consequential effect on impact i might have been for the new paradigm as we go forward. the third of the administrative and regulatory efforts underway now in the executive ranch that dennis has talked a lot about. there are three components in the administrative and regulatory framework that are all very critical. the first is the one we heard the most about having seen among seven nuts insurance reform. new protections, the fact that we no longer will have to deal

with preexisting conditions are like 10 minutes come in your limit, something byron and a lot of time working on when he was in the senate and bob then as well. bob was just extraordinarily effective leader on the republican side on many republican -- these reforms that both republicans and democrats are seeking answers to. so insurance reform, now most evidenced by the creation of these 50 exchanges in august august 8th and was new protections, new products, new service is all in the exchange marketplaces. that will be the first component that will have a profound effect as we go forward in virtually every american, whether an individual marketplace or not. the second component is not getting as much tension is supposed to go forward and that is meaningful payment reform. one of the biggest cost driver is of course these are fee-for-service system that

produces -- providers of our health care marketplace today in large measure i rewarded for greater body of that's got to change that and we will change that by changing the payment paradigm away from fee-for-service, decapitated, bundled and globalized approaches. that is going to have a huge and very, very consequential effect on the health care is provided as we look to the next 10 years. the third is delivery reform, recognizing the importance of good quality and importance of best practices, recognizing ways with which we can do things better. that authority under way of. we see enormous change with regard to the way kerry delivered, especially through now, electronic devices, more applications in health i.t. as we look to all of that, there is little doubt that health hea. will be the nerve center of this new health paradigm going

forward. i'm very excited about the prospects there are for doing that. so that's the executive and legislative -- executive, legislative and legal vagaries. before this what is happening in the states themselves. they are really becoming incubators of change. every state, regardless of whether they are participating in a federal or state exchanger becoming the really good readers of transformation and it's exciting to see what is happening in virtually every state today. innovation has exploded. i just attended and innovations them in ohio at the cleveland clinic that was remarkable to see the new and exciting things going on in the state and not leave me to the final level and that is the private sector. that is where the greatest degree of innovation is really taking place. enormous change at all levels. payment, delivery, insurance reform, new products, new

opportunities, far more transparency, far more personal capacity for patients and individuals to be involved in their own health with a greater and greater emphasis on wellness rather than illness. so those are the five areas with which i think she will see enormous change over the course of the next 10 years, change it think it's exciting, change that brings us closer to the high-performance, high-value health care marketplace that i think republicans and democrats, liberals and conservatives all aspire to. in closing, i would simply say there are four important test of leadership that will ultimately determine whether or not we're successful. the first test of leadership is resilience. any transformational moment, we know there's going to be setbacks. we know there's lost yardage and fumbles and a great deal of

frustration. we know that there'll be losses and gains, but the real question is, with each time we are knocked down, each time we are stuck with a loss, how resilient will repeat? how evil are we to pick ourselves up, learn from experience that move on? i think americans are very resilient people. we shall not now for more than 200 years. and we did a fascinating book called the man who united the state. it is an extraordinary book about the resiliency that our country has shown now ever since i was sounded. i believe we will show that resiliency again in this even more transformational moment for health in america. the second is innovation. boy do we need it now. if necessity is the mother of invention, innovation is really the key.

and i believe we have already begun to see the capacity for innovation all across this country and both the private and public sectors. we are going to find innovative and new ways with which to address our health challenges in some context that we have been in out of today as we began to look at the exciting possibilities. clearly innovation is key. the 30th collaboration. we have to recognize that in this fragmented series of subsystems, we truly need to work even more closely together. that's why georgetown is to be saluted for the work they are doing and bringing us together today. the collaboration like this, collaboration among providers, collaboration between the government and private entities that recognition ready to integrate a lot more effect if we, become more cohesive is clearly a very key test we all

will face as we look at the future. the final issue is engagement. those who believe they can sit on the sideline and not be engaged in public policy fail to recognize the importance enter relationship that exists between public and various and help at all levels. we have to be willing and prepared to be as engaged as if our lives depended on it. because the view. so i would simply restate the need for resiliency, the need for collaboration, the need for innovation, the need for engagement to determine whether or not we are as successful as i know we can be in this transformational moment. henry ford once said, coming together is the beginning.

stay together is progress. working together, that's success. let's show we can work together as a country, facing this challenge and prove to future generations that we were up to the task of building a new transformational health care marketplace for all. thank you very much. [applause] [inaudible] >> hi, senator, it thanks for your remarks. [inaudible] high-performance, high-quality

marketplace. stopping with that word, chief we are ultimately headed is a marketplace for health insurance plans? in other words, in exchange system that includes a larger share of the population so the risk was larger, the risk can be spread more uniformly and there's more competition among plans to give us more incentive for quality and cost control. and if that is true, noting that the affordable care of it only takes us so far in that direction, where is the next step? >> that's a great question. could you hear the question in the back? good, okay. again, in the interest of time, i haven't elaborated on my foot oilfield metaphor, but this is an opportunity to talk about it.

i think what the affordable care act does is allow a to b. on the foot oilfield for the first time in a meaningful way at about the 30-yard line. that is, i think we've got 70 yards to go to reach our goal. and now the categories that i probably collided over too quickly. we have a lot of work to do. we aren't anywhere near the quality coming near the access. we may or may not being at the cost containment aspirations we have permanently. but this is going to take a lot more work and even more legislation. we don't have the capacity simply through the aca to get to the goal line in and of itself. what we've done is that the framework in place, creating a new paradigm that will allow us to make real improvements in all those areas. now i can take my fumbled metaphor certainly to this football field because there's

been a lot of fumbles. i am hopeful we can share the resilient need to keep going down the field, closer to the goal line over time. i'm confident we will, but it's going to take everything i said its tests of leadership to make that happen. >> thank you. thank you very much for your wonderful talk cannot you send. i would like to ask a question about what you described because it seems to me that one of the reasons we have the wrong incentives and the tears invest huge amounts of money and innovation development intact elegies who are there. are there additional policy changes needed that are not currently in the aca that could help flip that incentive structure and get the private

sector to create for back is a better term, and industry science-based? >> i appreciate that question a great deal. the answer is we have put in place a number of new policy components that will begin to allow us to cover the entire. and it. i don't think we'll ever find the time when the american health sector diminishes in terms of imports and its reliance on technology. we are technologically driven in this country and that is a great asset in many respects, but a liability as well. it is an asset in that we've allowed the most technological means to be used in some cases that it made a difference. some people confuse our technology with our system, our marketplace. we have the best in the world.

but we don't have the best sector in the world if you look at any performance criteria. i think we're the best technology in the world. a lot of people around the world want to access that technology. succumb to the united states to be able to do that. but what this law does and what i think a growing consensus, even in the private sector outside the law acknowledges that if we are really going to make a difference in the new health paradigm, we've got to come to the bottom of the pier made and recognize that through the efficiencies are, greater emphasis on wellness, some illness not only produces better results, because less money. so it isn't that it has to be either/or. our goal is to cover the entire pier made. putting the balance. these could be with a far greater emphasis in reliance on bottom of the pyramid care than

ever in history, this begins to do that. it is still going to take a lot of additional effort. the eerie medical school this year and we were talking before about the emphasis on internal medicine and the need for more primary care and are just delighted to hear one of the top schools in the country now been offered good, primary care education and internal medicine opportunities. so i believe it is coming. but it's a crass expression, but it is true you got to follow the money. you have to follow the money with regard to impersonate, with regard to educational opportunities and where the money is for assistance first goodness. father money. i think it's very, very critical. we've got to find better balance with the way care is provided today. let's give nurses more authority than they have today.

nurse practitioners, physician's assistants, pharmacists. we can do better and knitting mills as we look at good religion and wellness as well. >> my name is rachel gore won the academy for state health currency. what areas you mentioned the role of state. i was wondering if you could talk about what the long-term consequences easy for the different experiences people will be having from state to state. a state like new york where they've done a marketplace in their expanding a decade, consumers are having a much different experience than maybe mississippi that has a federal marketplace and aeronautics unit. speak not well, i've always thought that having remodels first aid exchanges is really a very good thing. we have the state models and we are at the are these the united states to california and

kentucky in a number of states, washington, connecticut, obviously massachusetts, they've done extremely well and their performance out that to be highlighted and studied as to what it is they're doing that other states failed to do so far? the second model is the hybrid model we got partial federal involvement and partial state involvement. there's a lot to be said for that model as well. maybe the federal government is in a better position to do something that the states can't do. especially in rural states like byron's and mine in particular, we may not have an adequate risk pool small states to be able to hinder the actuarial challenges that will be facing going forward. so it could be the hybrid is the perfect solution for things like that. and then of course you have the federal exchange of those who

believe we have to try to nationalize our health care sector even more. we'll see whether ultimately we can make it work. the early winning of course would argue states do a better job than the federal government at setting up the exchange. but it's early and it's too early to make any determination in that regard. i also think the states right now are doing such exciting as with regard to pilots and studies underway across the board. delivery reform, aco's. you've got a lot of new organizational test that will be examined, studied and we will learn a lot from that as well. and then i of course haven't mentioned medicaid. you verity god 26 days that have signed up so far for the medicated mansion and ultimately all 50 states will do it.

something from an economic as well as health point of view is too good to ignore. you're going to see tremendous innovation, a lot of engagement and several spectacular examples of good health leadership and from that, we're going to claim a lot of information that will be applicable as we look to the future of health nationally and some decisions about public policy going forward. >> thank you very much. >> thank you are very much. [applause]

>> i didn't get the idea for the for dummies series. i had an idea to do a book about computers, done specifically. i kind of inspired myself to do that just dealing with people in a magazine editing job i had, been on the radio at that time and not in the public and talking to people about computers. it was obvious people want to learn more, that the material we had available is doing the job. we begin to books on how to use computers, but they substitute. they were condescending, peach amazing. the author is arrogant. you say to never get get this stuff anyway. look at this, this is cool. people didn't want to know that. they wanted to use a computer. idg original plan to publish one book. even then, there were several but the with the title when the

owner found out they had this book, "dos for dummies" at press. you can't defend the reader. cancer that. unfortunately -- fortunately, 5000 copies came off the press. originally 7500, but they stopped at 5000 in the figures will show that in the marketplace and it will just go away. at the time, not all the bookstores even wanted to have it. waldenbooks said no, we don't want to insult the reader. we don't want that. even with 5000 copies out there before the internet, when we had bookstores, real bookstores that people wanting to come and they came in and it was gone. any week of the sold out because people wanted it. it was like a solid and said said that is for me. i am a dummy. i want that book. >> today, there are more than 250 million "for dummies" books. find out more this weekend as

booktv and american history tv look at the history and literary life of port of mine, idaho saturday afternoon on c-span2. >> coming next, today's "washington journal," republican congressman duncan hunter join us to talk about the nuclear arms deal with iran. congressman hunter is a member of the armed services committee and we will bring you as much of this as we can until 2:00 when whooper unified reefing by defense secretary chuck hagel and martin dempsey and the joint chiefs of staff. >> we want to welcome for the first century table, congressman duncan hunter has its own house and. and they begin with the orang nuclear deal. in the "washington post" this morning, this is how they begin their story. at a beirut come a surge of diplomacy and outburst of violence in the day since world powers reached a deal with tehran illustrate the promise and peril of what could be the

start of a more peaceful area in the middle east. or the beginning of a new round of bloodletting. which do you think it is? >> i don't think anything has changed. they're both probably completely wrong. you will have every infield for the last decade. even if they stop short of being able to enrich to a nuclear capability, they'll still be building up their ballistic missiles and ability to reach further and further in his southeast europe in different parts of israel. even if they stop the enrichment capability just short of what is permissible under this new deal, they'll be able to spread to that in a month or two and on their ballistic weapons, which they are still making in droves. i don't think this has anything frankly except give them a leg up in some cover in the international community. that's what this is doing. i don't think -- we are not

going towards a safer world because they're not having to actually do anything with this deal yet. nothing even starts until six months out. so i don't take this a good deal for the united states or free world. >> host: what about it do what you like? >> guest: it doesn't make them do anything. i was totally open up to the iaea, whatever international want to go win. they have to start building centrifuges and they have to start spending and enriching. at that point, once its verified companies say okay, we're going to lower sanctions. you don't lower the sanctions first in prayer rambled to the right thing for once in a generation because they proved over and over the last 30, 40 years that they don't do the right thing ever. so i assume this time it seems like it would be folly and almost ridiculous to think they'll be different this time just because over the last generation they haven't been

honest. they have not been trustworthy and they haven't done what they said they'll do. >> host: cars and a great remix of democrat was on the show yesterday. he is in favor of this deal. i want to show you and our viewers what he had to say and get your reaction. >> i think when you look how it was negotiated, clearly the transparency that this never happened before. and where we would be had we not had this agreement, if this agreement was not in place, there's nothing to stop it from continuing to enrich and move towards a nuclear weapon. this agreement stops that. so that's significant. in return, we are not removing the sanctions placed on iran by the congress. we're talking about a man gives relief to some eight to $9 billion, primarily for

humanitarian and medicine purposes, which is miniscule compared to the oil sanctions continue and iran continues to lose 30, $40 billion. so the eight or nine william dollars they get is nothing in comparison to the continued siege that is plaguing our department. >> host: congressman, your thoughts. >> guest: the state department actually said the next step here is continuation of a working level so they can essentially to you the implementation of the agreement as she says obviously once that is done, this tech discussions will work through. i guess the clock would start coming meaning there is no deal right now. iran of having to do absolutely nothing. america and international partners were all given an stuff right now, believing sanctions and be nice to them and making

overtures. there is no deal right now. iran is still enriching. iran is still building ballistic missiles and the ability to launch their nuclear capability. once again, even if they stop enriching right now, that doesn't mean within two months when their supreme ayatollah says we want nuclear capability, it takes them up and have to get there. that's unacceptable and that should be except the bolt to the international community, israel or the united states. >> you wrote in "usa today" that the nuclear ambitious iran is reminiscent of america's sprint more than two decades ago to halt north korea's development of nuclear weapons. iran constitutes an even greater threat to the world. to think of iran as any differently as would have in north korea would be foolish. explain. >> guest: absolutely. you ran the thing much more dangerous foe. or as korea has china to keep it in check.

they have russia to some extent. south korea, north korea has kept in check you would hope by china, their ambitions economically and one in a peaceful resolution to the north and south korea. iran doesn't have it. there is no check on iran. there is to india, check. iran has no check at the sanctions because there is no country by israel in that community that has or will have the same nuclear capability. to be frank, iran's government the way that it is driven by radical extremist muslims, that is different from a cell preservation mindset that north korea has intended the old soviet model. that is different from iran's government. when you have the rain and sponsoring terrorism, that doesn't stop right now. there's still sponsoring terrorism, syria, iraq and all over. the sanctions do nothing towards

that come in many iran hasn't changed at all. there is no check and why i think there were dangerous. what a lawyer for god, then make super dangerous than a sense of the most people in most countries have. it makes them easier and pretty much more on this. other countries are in wanting to stay alive. i don't think he radiance have that. a lot of folks in afghanistan and iraq when i was over there don't have that sounds a preservation. they don't mind strapping bombs on the kids. that's who you're dealing with what they ran. they are rational actors in this. >> host: congressman, after the september 11th attacks in 2001, quit his job, join the marine corps and served in iraq, how many times? >> guest: twice in iraq. i served in too many hello, where babylon is in 2003 in falluja in 2004. afghanistan at 2007. >> host: do you think war with iran is inevitable?

>> guest: i sure as hope not. let's put it that way. i think a ground war in iran, with american boots on the ground would be a horrible thing. people like to toss around the fact we have to stop them in some way from getting this nuclear capability. i don't think it's inevitable, but if you have to get it wrong, you had it with nuclear devices and set them back a decade or two or three. i think that's the way to do it. a massive aerial bombardment campaign. that is still a huge undertaking that cost billions and millions of dollars to do it. i don't especially after iraq and afghanistan. america knauss knows his limitations in that area and what we can do. we want to spend 12 years after we tear it down to build it up again so does it run by a crazy to radical leader that has happened in iraq and afghanistan. you've got a crazy guys running the government there. unfortunately what we've done to set that up has played a role

most countries do not and great actors still. >> host: will get her first song: just a second. congressional action on this. secretary of state john kerry, the white house asked members of congress not to vote on a new round of sanctions against iran. secretary of state is going to testify next week before the house foreign affairs committee. will congress wait until after he testifies? >> guest: congress should not wait. we should have an administration and congress, so in love with the idea whether they did something or not that they are blind to the reality. we should proceed with sanctions if the rain and snow that this is not an american deal with them. this is a carrier bombing deal with them on the rest of congress is now behind them. the u.s. senate, and they still want to impose sanctions. this is going to be very hard for them to say we are going to trust you ran and hope they do

the right thing for the first time in 40 years and most of it happens. >> host: in athens, ohio, democratic caller. hi, william. >> caller: the evidence that the world trade center was brought down with explosives of 9/11 is real and proven. more and more people wake up every day. how much more trusted the american public does congress have to lose before cases reality and acknowledges the need for new investigation into destruction? >> guest: i don't think it needs any more investigation. i think the way those towers are brought downward by radical islamic terrorists and that's the way it is in every investigation has shown us so far. >> host: did she read? [inaudible] >> guest: jack, i think so. >> caller: yes, good morning, representative hunter. i remember in the past president

clinton was stealing and they are having a problem with their missiles on launch pad getting off the launch pad and their guidance systems. after they made deals with clinton, it appeared that clinton sold them or gave them a guidance system for their icbms and they were able to successfully launched their icbms. with accuracy. it wasn't long after that, just a few months after that their minister of war was threatening the united states over taiwan. also, you got to remember what madeleine albright went to north korea and dealt with the leader at that time over nuclear power plant and supposedly they wanted uranium for the nuclear power

plant. they took back uranium and refined it needed in to a nuclear weapon. they also got missile systems in china. i do not trust this administration dealing with iran at all. i think will come out on the losing end of it. >> host: congressman? >> guest: i agree. all things he basically said the same thing. >> host: the american heritage in this paper to a lower the sanctions first? as a gesture command can put sanctions back, can't you? >> guest: is harder that way. once you let the monkeys out of the barrel, he'll have iran getting into opec now. they'll have to make room for oil. you let the iranians know that we're going to reward you for being bad. you reward good behavior.

i don't understand the logic once again. it seems like total folly to believe that iran would be different than the last 40 years. that is kind of silly >> guest: we have to do with the way it is. in our brain back to us and we should proceed with that in mind with the parameters. if you go back during the cold war, we have been burned by trusting the people we are negotiating with are negotiating in good faith like we are. not everybody has that honesty or integrity, transparency that we have in this country. when you talk about the soviet

union, north korea, we've got burned over and over because we trust and verify. >> host: congressman come is the u.s. prepared to lead by example and destroy its refinement. >> guest: ayn rand is a bad actor. the united states is not a sponsor of terrorists. >> host: democratic caller, hi christian. >> caller: i have a couple of things to say. first of all, i cannot believe that this gentleman who was lied to when he went to iraq isn't more upset about bush and his administration sent in and killing 2300 soldiers, spending trillions of dollars, basically bankrupting us. and also the thousands of soldiers that are coming back maimed. this guy wants to talk about let's give peace a chance? i think he would talk to buddy isaiah and find out why the bush

administration talk about why you and your boys and rents have the proper body garment. for you to stay here and talk about being disingenuous? look at what the republicans had done to the middle east in the last 10 years. another thing i would like to say. like my buddies at the other day. you guys always say israel is our closest ally. how many israeli soldiers died in the afghanistan war. how many israeli soldiers died when we're over there or you are over there fighting in iraq? we always talk about israel does, israel back. they would not even do president obama. he can't dance and a or forget the coalition. they should have been the first one with her coalition. >> guest: first thing, christian, what is real we didn't want to miss her coalition because there's some

problems between israel and palestine and would make things more complex and we would have been able to get a lot of our partners and allies that we got in iraq and afghanistan. i think israel understands that. at the same time, israel helped us to the wars in iraq and afghanistan with intelligence and things like that. putting them in the coalition and have been israeli boots on the ground in these countries, would have had more gesture meant that benefit. number two, president bush didn't kill any soldiers, marines or sailors. radical islamic terrorist state. we are to iraq for the right reasons and we know now that aside has used these chemical weapons that iraq had, the iraqi chemical weapons went straight to syria and assad has had them since. i think we went there for the right reasons. we underestimated what we needed to do after the initial attack

and after taking over the entire country, whether we take to build a backup again. i did two tours in iraq. a lot of my marine brothers lost their lives there or came back wounded as they say. we don't have a single soldier. we don't have a standing military presence in iraq right now. aaron is left unchecked by iraq be a serious left unchecked and the 10 years we spent there now, we don't have anything to show for it. we don't have anything because this president squandered with what the military did for 10 long years and not work. >> host: i want to give your thoughts on the impact the deal might have on peace in the middle east. the "washington post" has a piece this morning that says turkey, for example, staunch backer has joined öland, assad's ally. a date has been set for a peace

conference in geneva aimed at launching direct talks between serious warring faction. the positive outcome of this nuclear deal. >> guest: i don't think it's an outcome of this nuclear deal. i'll think turkey wants a nuclear weapon. these nations are either going to believe there's a need they truly believe or read has changed the turnaround will be good for now on. in that case, they are hoping that they do that so they don't have a nuclear neighbor. i don't think any of these nations want nuclear neighbors. as for rent goes nuclear, saudi arabia goes nuclear, a lot of cool states go nuclear and i'll do it very quickly. they'll have a nuclear middle east. so just take how combustible it is now, pretty nuclear invasion and think about these nations that have this infighting and civil wars and strife going on. now get them on nuclear weapons. other nations are not going to

allow iran to have one while they don't. go have a nuclear middle east. that isn't safe for everybody. that can't be allowed to happen. >> host: that answer this tweet from vivian. congress doesn't want peace in the middle east, doesn't want peace with iran. that's area. >> guest: once more come you have to be a realist on this. just because the united states wants peace, doesn't mean peace just happens all over. that's a little bit juvenile, too. you have to look at the last 30 years and how bad the fact did and say, are they going to change just like that? are they going to keep doing what they've been doing? once again, if they get a nuclear weapon, every country in the area will have a nuclear weapon. the question also comes, president obama spleen, the steel allows them to enrich uranium to a certain point. it only takes a few minutes to go from that point to

nuclearization. if that's where you want to have them wear brand two months away from having a nuclear weapon at all times, if that makes everybody happy, that's pretty scary. >> host: back to the "washington post." they also write this. sunni arab states don't object to deal that could curb iran's nuclear objections, but they worry about the ramifications of ties between tehran and washington said one security expert, the big worry he said at a long-term deal normalizing ties between iran and the united states took him at the expense of sunni influence. what do you think about this? expanded a little bit. they like to make friends with our past foes and kind of ignore our allies. this kind of plays into it. the saudi's will not be the greatest country in the world, women still can't vote in saudi arabia. women can't drive in saudi

arabia. it's not the greatest country in the world, but militarily and security wise, they've been allies of ours and it stopped a lot of things from happening on american soil, sharing intelligence and so forth. this administration likes to leave our allies on this side, like they did with egypt, saudi arabia, great britain and others would go to our foes and say let's appease you and that's how we're going to work. saudi arabia again, they don't want a nuclear iran. unethical states. dubai, abu dhabi. this is an economic center went abu dhabi and dubai, the last thing they want is a rant of nuclear weapons. capitalism and free market of western civilization, free elections, women can run for office in places like jordan, dubai, abu dhabi. the semi-westernized middle eastern states. the last thing they want for their burgeoning economies is to

be destabilized by a nuclear iran. so that's a big problem. if you want to look to peace in the middle east, look to these good actors doing great things in their country and bringing in reforms as fast as they can. we were then. don't reward the bad guys who said they want to wipe israel off the face of the earth. >> host: milo is next in jefferson, iowa. independent collar. >> caller: sir, i am honored to speak with you. i have a problem in the manner we are negotiating with these people, it is in a secular way. now, i don't think a lot of people understand that the ukrainians, their negotiations are totally and a radical, religious way coming manner. i don't think a lot of people understand that to them it is honorable and heroic to successfully live and defeat the

infidel, which is us, and the zionists, the israelis had i believe we are totally naïve to think that they don't -- that they don't understand what they're doing is actually defeat ms. and totally, totally their whole idea through their religion is to destroy us. >> host: congressman, how to respond to that? negotiating a religious way? >> guest: he is right. to a great extent. it's not like we're making this up. you said over and over were the great, the great evil. in the middle eastern culture, it is looked upon with high regard to get the best deal possible to matter what it takes. that's one reason these gold states like to work with the united states because her honest and transparent and we have laws that we have to live by, even in the business world. he likes doing business with us as opposed to their partners or

even the chinese to some extent because they like doing business with people honest and open and forthright. so that is i would say an underpinning to these negotiations. once again, if you want to blow yourself up and commit suicide in order to blow up other people, you are not a rational person and that is who you are dealing with what you do with iranians. >> host: are you saying all middle east countries at this way? willing to lie negotiations? >> guest: is part of the culture to get the best deal you can when you're arguing whether the marketplace for buying vegetables or shoes at the marketplace, to do anything you can to get the best deal. that's part of middle eastern culture. they like to barter. try going into a safe way of trying to barter for your food. they still do that in the middle east. the shop owner will say whatever he or she has to to sell some

and people barter back and forth to get the best deal for each other. he ran as the epitome of that because they've lied over and over. they are players. the radiant government by all the time. why trust them now? why trust them now? >> host: are you speaking from personal experience? >> guest: i would say not necessarily all middle eastern countries. that's a big generalization. they do business different than we do in the west. they have markets they like to barter. they do whatever they can and save whatever they can to get the best deal. >> host: congressman hunter served in iraq to two hours and also, might be familiar face but a familiar name to many viewers exceeding your father, congressman duncan hunter who retired after serving 14 consecutive terms. >> host: is that good, karzai, the president of afghanistan has

the same problems the iranian government has. meaning he's a little bit crazy. he's not trustworthy. he tries to get the best deal for himself, not necessarily his own people, but just himself. he's deceptive and is not an honest broker. you see that popping up in these backwards middle eastern countries more than anywhere else. >> host: that leads us to the headlines today about the afghanistan java secretary of state john kerry is trying to negotiate with nato, getting hamid karzai to sign it. the headline in the "washington post" as it is now in peril. >> guest: it has been imperiled this whole time. we want to sign during this last summit. it's about six months late. it's going to hurt america's ability and the international community's ability to help afghanistan because people want to invest billions of dollars if they don't know where the money is going.

i don't know what karzai's problem is. i truly don't. for all of the help of the money in the community has given to make themselves safer because afghanistan was the hot spot by the international terrorist and has nuclear capability. it's a really dangerous place. for all the stuff we've done for karzai, he just seems a little unhinged to me. once again, it is hard to negotiate with somebody who could be a little crazy. that is what karzai's problem is. i don't understand how it benefits him to not get the international aid that he's been offered and international support to build this country up in a freer, more westernized way. there is no upside except he gets to keep his kind of dominant hold on the afghan population. >> host: stephen illinois sends the same.

don't sanctions ultimately push ordinary citizens of the nation who were put under sanctions, the few leaders to live comfortably while citizens suffer? in other words, an from within. just go there was an uprising a few years ago. unfortunately, this administration didn't do anything to help it. so we let it slide down. the iranian brownshirts beaten and killed. hundreds have uranian regular people, students and people protesting. as a protest not against american sanctions, but the heavy handedness of the rainy government. this is not a free government were talking about here. >> host: hi tracy, you are in the air with congressman dncan hunter. >> caller: good morning. with all due respect, mr. hunter, it sounds like you want to wipe your ran off the face of the earth. you talk about having a nuclear free middle east except israel.

that is the agitated double standard. we should get rid of israel's nuclear weapons first and start from there. that's my opinion. that's not exactly while i'm calling. i noticed that there's a lot of oil-rich countries that decide to sell their oil and other currencies, there's an immediate drumroll of terrorists, rogue states. i could be wrong on this. tell me where i am wrong. it's just really, really comment to me to see they want to exchange oil. immediately we have to really go in there. we bomb them,, take over and said the government to get them back on the petrodollar. >> guest: i'm not quite understanding the last part of your question. you are saying when countries try to get off of their oil production, america goes in and bombs them and set them back up?

>> host: selling oil in another currency instead of u.s. dollars. the united states has an issue with it. >> guest: i have no idea about that. when it comes to israel, israel hasn't anybody. they don't want to wipe anybody of the face of the earth. they don't promote suicide bombings, terrorism throughout the entire world. they haven't tried to attack americans on american soil. iran has done all these things through proxy terrorists. you can't look at germany or france or the united states or israel or any of these three, transparent, western democracies and compares it therein. it doesn't work that way and i don't work that way. you have good actors and bad actors. you can see why they are good people are bad people, good nations are bad nations. you have to be a realist and say we aren't all the same. they were good countries and bad

countries. to help that country out, once again, if her rant came forward and said we will stop at all not today, there's going to be no more centrifuges spinning. you can come in and look at every single thing we have. we will be totally open, totally transparent. that's fantastic. that's the greatest thing in the world. everybody would be happy to see that. that's not what is happening here. don't be confused to the people watching. don't be confused with what the administration would like you to believe about this deal and the reality of it. they are not opening up nuclear reactors. they are not saying come on in, world, we will prove to you we are not making nuclear weapons. they are doing that at all. once again, why think that a bad actor is all of a sudden becoming a good actor just because you are relieving sanctions? >> host: at american treason, everyone tries to get the best deal they can. americans like to barter, maybe

even more. gail and mr. z has that. .. that the united states is wrong for trying to have a destabilized radical islamist nation, not have nuclear weapons and that we have to give something up for that to happen, that's just kind of silly. i think we a